Does Nonpayment for Hospital-acquired Catheter-Associated Urinary Tract Infections Lead to Over-Testing and Increased Antimicrobial Prescribing?
Clin Infect Dis. 2012 Jun 14;
Authors: Morgan DJ, Meddings J, Saint S, Lautenbach E, Shardell M, Anderson D, Milstone AM, Drees M, Pineles L, Safdar N, Bowling J, Henderson D, Yokoe D, Harris AD,
Background.?On 1 October 2008, in an effort to stimulate catheter-associated urinary tract infection (CAUTI) prevention efforts, the Centers for Medicare & Medicaid Services (CMS) implemented a policy of not reimbursing hospitals for hospital-acquired CAUTI. Since any urinary tract infection present on admission would not fall under this initiative, concerns have been raised that it may encourage more testing for and treatment of asymptomatic bacteriuria.Methods.?We conducted a retrospective multicenter cohort study with time series analysis of all adults admitted to the hospital 16 months before and 16 months after policy implementation in participating Society for Healthcare Epidemiology of America (SHEA) Research Network hospitals. Our outcomes were frequency of urine culture testing on admission and antimicrobial use.Results.?A total of 39 hospitals from 22 states submitted data on 2,362,742 admissions. In 35 hospitals affected by the CMS rule changes, the median frequency of urine culturing did not change after CMS policy implementation (19.2% pre-policy vs. 19.3% post-policy). The monthly frequency of urine culturing increased minimally pre-policy (0.5% increase/month) and had a slight decrease post-policy (0.25% decrease/month, p<0.001). In the subset of 10 hospitals providing antimicrobial use data, the median frequency of fluoroquinolone antimicrobial use did not change substantially (14.6% to 14.0% post-policy). The monthly frequency of fluoroquinolone use increased pre-policy (1.26% increase/month) and decreased post-policy (0.60% decrease/month, p<0.001).Conclusions.?We found no evidence that CMS nonpayment policy resulted in over-testing to screen for and document a diagnosis of urinary tract infection as present on admission.
PMID: 22700826 [PubMed - as supplied by publisher]